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Some Considerations about the Determination of the Surgical Incision Line in Gastric Cancer Surgery Toshinari Minamoto 1 , Masayoshi Mai 1 1Department of Surgery, Cancer Research Institute Hospital, Kanazawa University Keyword: 胃癌の切除範囲 , 胃全摘 , 切除断端 , 切り残し pp.303-311
Published Date 1990/3/25
DOI https://doi.org/10.11477/mf.1403110412
  • Abstract
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 This paper discusses some problems in determining more accurately the surgical incision line for gastric cancer infiltration, before or during surgery. It is desirable to avoid unnecessary total gastrectomy often done despite the limited extent of the disease. Out of 955 gastric cancer cases in which gastrectomy was performed at our institution there were 38 cases (6 early cancer, 32 advanced cancer cases) which might be questioned as to the choice of the best surgical incision line. However, 28 of 30 far-advanced cases with positive indications of cancer cells at the surgical cut end were excluded in this discussion because of the absolute impossibility of cure by resection, e.g., carcinomatous peritonitis, hepatic metastasis, massive nodal involvement and generalized metastases. We encountered 8 cases in which we were obliged to carry out additional resection of the remnant stomach due to positive indications of cancer cells in the surgical incision line discovered in the frozen surgical section. These included one case with latent linitis plastica carcinoma. Consequently, in case of superficial spreading carcinoma we should pay careful attention to the determination of the incision line. In order to examine the cancer infiltrating boundary, it is necessary to employ various imaging analysis such as clear double contrast picture, dye endoscopy before surgery and frozen section of incision line at surgery. On the other hand, advanced gastric cancer with questionable cancerous boundary showed histological characteristics of scirrhous stroma, and endoscopic ultrasonography is useful to give information concerning the extent of cancerous infiltration into the gastric wall. Nextly, unnecessary total gastrectomy was discussed for gastric carcinoma arising in the upper part of the stomach, especially early and small gastric carcinoma. Thirty five cases of early gastric cancer in which total gastrectomy was performed because of location at the upper part of the stomach were collected in this series. In 12 out of the 35 cases the diameter of the lesioned area was less than 5 cm in size without nodal involvement. It is concluded that early gastric cancer located at the upper part of the stomach and being less than 5 cm in diameter, can be expected to be cured absolutely by performing reductive surgery only.


Copyright © 1990, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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